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Does Surgery for Colorectal Liver Metastases Release Tumor Cells?

For sufferers with colorectal liver metastasis (CLM), surgical resection is the one hope for remedy, however typical hepatectomy entails mechanical manipulation that would launch tumor cells into the bloodstream and lead to additional unfold.

To attenuate this danger, an alternate methodology was launched in 1992 ― an anterior method for open proper hepatectomies, which entails much less manipulation.

Nonetheless, a trial that in contrast the 2 surgical approaches confirmed no distinction between the 2 in decreasing intraoperative tumor cell dissemination.

Circulating tumor cells (CTCs) have been detected in 6 of 22 sufferers (27%) within the anterior hepatectomy group and in 5 of 21 (24%) sufferers within the typical hepatectomy group, the research authors report.

Working time was longer with the anterior method (221 vs 171 minutes), however intraoperative and postoperative outcomes have been comparable for the 2 approaches. Median general and disease-free survival have been additionally comparable (55 vs 73 months and 48 vs 40 months, respectively), as have been recurrence patterns, report Nuh N. Rahbari, MD, and colleagues. Rahbari is affiliated with the College of Heidelberg, Heidelberg, Germany.

The findings have been published online November four in JAMA Surgical procedure.

This “well timed” trial “addresses the issues of many liver surgeons about detaching and shedding most cancers cells into the hepatic veins through the preliminary mobilization of the suitable lobe,” remark the authors of an accompanying editorial, Iswanto Sucandy, MD, from the Digestive Well being Institute, AdventHealth, Tampa, Florida, and Allan Tsung, MD, from the Ohio State College, Columbus, Ohio.

“The medial rotation to get the suitable lobe out of its anatomical confinement is commonly mechanically rigorous (and probably traumatic to the tumor and remaining parenchyma), however it is rather useful in facilitating later steps of the operation,” they write. “It appears intuitive and simple to extrapolate that this maneuver can enhance the discharge of CTCs into the systemic circulation, thus resulting in an inferior oncological final result.”

Nonetheless, this assumption seems to be unfounded in gentle of outcomes from this newest research, they level out.

“The almost certainly cause for these findings is that surgical methods for CLM resection play a minor position in contrast with these of tumor biology and affected person responses in affecting the metastatic cascade,” they recommend.

Tumor Cell Unfold Stays a Concern

About 70% of sufferers expertise hepatic or extrahepatic recurrence after typical hepatectomy, notice the research authors, so the priority over tumor cell unfold throughout surgical manipulation stays.

Though their research was restricted by small pattern measurement, the absence of bone marrow samples for eight sufferers, and early discontinuation of the research per protocol, the authors say the findings “don’t assist additional efforts to scale back tumor cell dissemination and subsequent illness recurrence by minimizing intraoperative manipulation.”

The findings ought to “slightly immediate methods to stop spontaneous tumor cell dissemination and to focus on minimal residual illness after probably healing resection.”

The editorialists add that the outcomes of this research present additional insights and factors for dialogue concerning the advantages of minimally invasive approaches to liver surgical procedure, which have been proven in a number of research to lower dissemination of CTCs by decreasing surgical manipulation of tumors.

The research was supported by the Division of Surgical procedure, the College of Heidelberg. The research authors and the editorialists have disclosed no related monetary relationships.

JAMA Surg. 2021;156:31-40. Abstract, Editorial

Sharon Worcester is a reporter for MDedge Information, a part of the Medscape Skilled Community.

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